PREGNANCY OPTIONS COUNSELING TECHNIQUES

Adapted from: Perrucci A. 2012

When providing pregnancy test results, some patients will be surprised while others will have taken a test at home and only seek confirmation. In either case, the patient may or may not require support in their decision making process. Our role is to listen and provide them with the appropriate level of support to come to a decision about this pregnancy, if they have not already (Singer 2004). When providing positive results:

Be clear what the result means: “Your pregnancy test came back positive, whichmeans you are pregnant.”

Allow some time for the patient to process the information.

Use open-ended questions to start, such as “How do you feel about this result?”

Avoid assuming how a patient will react to the result.

For many patients the decision to have an abortion is clear. They won’t need options counseling; we can help them with planning the next steps. Gauging this is important to respecting their decision. Similarly, avoid making assumptions about what emotions the patient may be experiencing or the reasons behind them. For example, avoid assuming abortion itself will be a sad experience; even if the patient shows sadness, Some people are actually sad about their life circumstances leading to the choice to have an abortion and ultimately feel relief after completing the process (Rocca 2015). For patients who are less sure, provide basic information in a non-directive manner.

I want to look at this situation with you so you can come to a decision you are sure of.

No matter whether you choose to continue or end this pregnancy, a decision has to be made, and some patients feel conflicting emotions.

What part of this situation is challenging for you?

Is there anyone in your life who can help you in a supportive way, without judging you or pushing their opinions on you?

The following framework and examples may assist your counseling conversation

Helpful Exercise for Ambivalent Patients

Try to have the patient imagine their life and how they might feel about this decision now and in a few years, depending on the choice they make. “What is your picture of the next year or five years of your life? How does this pregnancy change or affect your goals?”

Continuing Pregnancy

Ending Pregnancy

Pros:

Short Term

Long Term

Cons:

Short Term

Long Term

Dealing with Spiritual or Moral Conflict

People of all faiths and religions have abortions. You do not need any background in religious or spiritual matters to talk to patients about abortion. You do not have to know the answer to the patient’s dilemma. Explore what this conflict means for them and what is getting in the way of their feeling like a good person. It may be beneficial to make a plan with them that can include readings (Maguire 2001), internet resources (www.faithaloud.org), discussions with their own clergy and/or a pro-choice religious group, or other counseling referrals.

Patients can experience moral conflict when they seek abortion and they believe that life begins at conception and that abortion is an act of murder. The counseling framework discussed above can be helpful to explore the patient’s beliefs and whether they allow for exceptions that can help them reconcile this conflict.